HomeMy Public PortalAbout4940 ARDSLEY DR_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING 2 .,,L� , COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
clTv ZIP BUILDING AND SAFETY DIVISION
OBLOGS. BUILDING
SIZE OF LOT )C��C`i NOW ON LOTADDRESS '
TRACT4`p -n BLOCK LOT N04-:1 LOCALITY
TEL..oZ 7��, NEAREST
OWNER NO. ��tJ'K77 CROSS ST. c-
ASSESSOR
ADDRESS � � MAP BOOK L- PAGE CEL
DISTRICTGROUP TYPE FIRE PROC S€D BY
CITY ZIP i. CONST. ZONE
ARCHITECT OR TEL. ��, L' x' � __3
ENGINEER NO.
STATISTICAL CLASSIFICATION EWER MAP
ADDRESS - CLASS No-,,2ZDWELL,UNITS -� BK_S
CONTRACTOR, ZLDa-S NOL.3-;;7-711 P lJ E ZONE MAP
LIC. NO. � -
ADDRESS (j, S'. LIC ZZ�CID SPECIAL
` I, LIC. ? CONDITIONS
CIT YW. -r, �,V.�N� CLASS .�.� ROAD DEPARTMENT APPROVAL REQUIRED YES NO
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRONT PROP,LINE OF (STREET)
ADDRESS CITY HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ. FT NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE 7 STORIES FAMILIES ONE
DES-CRIPTION OF WORK �'' ` { N `( +, NEW CD
❑ BLDG.SETb'ACK FROM CD
•� 1 eavL.occ_ ADD ❑ SIDE PROP. LINE OF (STREET) O
ALTER ❑ HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING CD
REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH LaJJ
EXISTING BLDG. � DEMOL E] Z
APPLICANT TEL . CORNER CUTOFF YES ❑ NO
(PRINT) ( 'a ��S NO. .7Z1 Cc7
IN OPEN SPACE YES NO
BY (SIGNATURE) � @
i IN COASTAL PERMIT ZONE YES NO
VALUATION i5-o
I HEREBY ACKNCJWLEDGE THAT 1 HAVE READ THIS APPLICATION "
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- -
STRUCTION. I CERTIFY THATIN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE "
LABOR CODE OF THE STATE OF CALIF NIA IN RELATING TO
WORKMEN'S COM;X ATION INSURANCE.
SIGNATURE OF - -
PERMITTEE nom,
ADDRESS /. `" 1 M
FINAL BY
CITYNOL DATE
.4IAKE CHECKS P.-1YAf3LE 70: P.C. $ PMT.,$"
FEE FEE
HARVEY T. BRANDT, COUNTY ENGINEER 1-7 �
(.
PLAN'CHECK VALIDATION CK. ' M O. CASH PERMIT VA ATION cK. M o. CASH
LIU; �`i23 U :37.35_
4 Z) _-)tiJAi L 4 2 3 U 243Jb v
- -- J O r JAN 14 :, (V l.1 .'] A •o
76A638A CE#803 574 -- -
APPLICATION
FOR APPLICANT TO FILL IN (P'rin't or type only') �TY OF M
BUILDING % " DER ME-NT OF C LINTY ENGINEER
ANGELES
ADDRESS V I _0
CITY
Z I P UILDING AND SAFETY DIVISION
/ NO.OF LOGS. BUILDIN /
SIZE OF LOT NOW ON LOT ADORES
TRACT BLOCK LOT NO. LOCALITY
TEL. NEAREST
OWNER �' •`,'�• NO. - CROSS ST. :'1�
ASSESSOR
ADDRESS l MAP BOOK PAGE PARCEL
j 7 DISTRICT [GROUP_ ITYPE FIRE I P CESSED BY
CITY / ZI CON yam/ ' ZONE _ /J�
ARCHITECT OR TEL.
ENGINEER NO. r— - -
,.. _ STATISTICAL CLASSI ICATION SEWER MAP
ADDRESS --'- CLASS NO. L OWELL,UNITS - BKa p
CQNTRACTOR,j- _ ' EL•. USE ZONE MAP
LIC. NO.
-ADDRESS °% - Np,. �' ` -SPECIAL
LIC. CONDITIONS
CITY
CLASS `0�• ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO.❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM y
FRONT PROP.LINE OF (STREET) d O
ADDRESS '!"- CITY = TOTAL SETBACK FROM TYPE OF EXISTING U
HIGHWAY } YARD '
SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE O
_ F-•
DESCRIPTION OF WORK NEW ❑ + LLJ
ADD ❑ BLDG.SETBACK FROM N
�,. Eyi SIDE PROP. LINE OF (STREET) Z
ALTER HIGHWAY } YARD -
- TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH
USE OF t- 1 = 07-
EXISTING BLDG. •- DEMOL ❑
APPLICANT "i.... /,.• Q TEL/`4j / CORNER CUTOFF YES ❑ NO
(PRIN.T) � aO.
'
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO
- ,-,`
- IN COASTAL ZONE YES ❑ NO
VALUATION �� 7. CATEGORICAL EXEMPTION YES❑ NO-0
1 HEREBY ACKNOW LEDGE T416 I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND.AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWSREGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN .RELATING TO
WORKMEN''-'S COMPENSATION INSURANCE.
SIGNATURE OF
PERMITTEE -'
ADDRESS__/ -
rJ� TE LK' i'� FINAL / B// ��
CITY DATE ®fyK/a
LIKE CHI= hS PAY:A13L-E 70: P.C. $ PMT.(
HARVEY T. BRAN T, COUNTY ENGINEER FEE FEE 4'
PLAN CHECK VALIDATION• CK. M.O. CASH PERMIT VALIDATION cH. ) M.O. CASH
3 9 8 273 DEC 5 1 D 2 8 .5 UA
76A638A CE#803 12/72 _